SUMMARY

We have abundant biological and clinical evidence as to why veins are less desirable than arteries as CABG conduits. If multiple arterial grafting were a pill, surgeons would most likely prescribe it every day to most patients who undergo CABG based on the currently available data—its current low uptake likely reflects not lack of evidence, but rather the technical and time demands of the surgery. We do not need more studies to tell us that multiple arterial grafting is the gold standard—that was well defined by Lytle et al. 2 decades ago (2). What we need is dedicated subspecialists and designated centers of excellence for myocardial revascularization, which can carry arterial grafting forward in the United States, as Royse et al. (1) and others have done in Australia. Without question, there is a significant population of patients who should be considered for a second arterial graft, and there are also many patients who would likely benefit from total arterial revascularization. We have done enough talking and publishing—now we need to get to action.